Healthcare Provider Details

I. General information

NPI: 1467668848
Provider Name (Legal Business Name): SUSSAN SADEGHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 K ST NW STE 900
WASHINGTON DC
20037-1810
US

IV. Provider business mailing address

12554 RIATA VISTA CIR
AUSTIN TX
78727-6431
US

V. Phone/Fax

Practice location:
  • Phone: 202-223-9722
  • Fax: 703-280-5098
Mailing address:
  • Phone: 512-795-5100
  • Fax: 512-795-5122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberU1123
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: